☆ 4.8 Article

Orbital floor repair using patient specific osteoinductive implant made by stereolithography

BIOMATERIALS (2020)

Journal

BIOMATERIALS

Volume 233, Issue -, Pages -

Publisher

ELSEVIER SCI LTD

DOI: 10.1016/j.biomaterials.2019.119721

Keywords

Orbital floor; Patient specific implant; Stereolithography; Poly(trimethylene carbonate); Hydroxyapatite; Sheep model

Funding

National Natural Science Foundation of China, NSFC-DG-RTD Joint Scheme [51361130034]
European Union [NMP3-SL-2013-604517]

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Abstract

The orbital floor (OF) is an anatomical location in the craniomaxillofacial (CMF) region known to be highly variable in shape and size. When fractured, implants commonly consisting of titanium meshes are customized by plying and crude hand-shaping. Nevertheless, more precise customized synthetic grafts are needed to meticulously reconstruct the patients' OF anatomy with better fidelity. As alternative to titanium mesh implants dedicated to OF repair, we propose a flexible patient-specific implant (PSI) made by stereolithography (SLA), offering a high degree of control over its geometry and architecture. The PSI is made of biodegradable poly (trimethylene carbonate) (PTMC) loaded with 40 wt % of hydroxyapatite (called Osteo-PTMC). In this work, we developed a complete work-flow for the additive manufacturing of PSIs to be used to repair the fractured OF, which is clinically relevant for individualized medicine. This work-flow consists of (I) the surgical planning, (ii) the design of virtual PSIs and (iii) their fabrication by SLA, (iv) the monitoring and (v) the biological evaluation in a preclinical large-animal model. We have found that once implanted, titanium meshes resulted in fibrous tissue encapsulation, whereas Osteo-PMTC resulted in rapid neovascularization and bone morphogenesis, both ectopically and in the OF region, and without the need of additional biotherapeutics such as bone morphogenic proteins. Our study supports the hypothesis that the composite osteoinductive Osteo-PTMC brings advantages compared to standard titanium mesh, by stimulating bone neoformation in the OF defects. PSIs made of Osteo-PTMC represent a significant advancement for patients whereby the anatomical characteristics of the OF defect restrict the utilization of traditional hand-shaped titanium mesh.We propose a work-flow to design and fabricate biodegradable and bone-promotive patient specific implants to be used in craniomaxillofacial surgery for bone reconstruction.

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Mechanical properties of porous photo-crosslinked poly(trimethylene carbonate) network films

Bas van Bochove, Dirk W. Grijpma

Summary: The study investigated the impact of pore characteristics on the tensile properties of porous network films, finding that elasticity modulus decreased with increasing porosity, regardless of pore size. Network films prepared by stereolithography showed slightly higher values of elasticity modulus, maximum tensile strength, and toughness compared to those prepared by the salt leaching method, possibly due to differences in diluent usage during the preparation process. Additionally, the presence of salt during crosslinking process may have contributed to a less efficient crosslinking process.

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